The Centers for Disease Control and Prevention (CDC) was once widely viewed as the gold standard in public health, considered an apolitical, science-driven bulwark against all pathogen threats, foreign and domestic.
Today, trust in the agency has plummeted because COVID-19 exposed the truth: The CDC is thoroughly corruptible, and federal regulators will never be impartial experts. They respond to political incentives just like everyone else, and a fact-driven, purely technocratic state is an impossible dream.
The Trump administration pressured the CDC to narrow the scope of testing so case counts would drop, blocked officials from doing interviews, and edited its flagship scientific reports. The CDC provided a scientifically dubious public health rationale for rejecting migrants at the southern border. President Joe Biden continued that policy, and under his purview, CDC guidance on school closures was surreptitiously written by leaders of the country's second-largest teachers union.
Tom Frieden, a former CDC director, co-authored a 2021 op-ed with three other former agency heads expressing hope that Biden's incoming CDC Director Rochelle Walensky would "restore the public's confidence in the CDC's scientific objectivity," with its reputation "a shadow of what it once was." Yet, Frieden endorsed large-scale protests against racial injustice two months after writing in The Washington Post that "the faucet of everyday activities needs to be turned on slowly. We cannot open the floodgates." Meanwhile, public health officials were keeping people from attending the funerals of their loved ones.
And could it be pure coincidence that the CDC chose the Friday before President Biden's State of the Union address to drop its indoor mask recommendation for the majority of Americans, even though the supporting data were months old?
In other words, it doesn't matter who occupies the White House—political incentives mean that, no matter how dedicated or competent the career scientists who work at the CDC are, the agency will never be controlled by fact-driven experts shielded from the "hurry and strife of politics," as Woodrow Wilson wrote. After decades of mission creep, the CDC's role should be strictly narrowed, limited to surveillance and coordination, leaving the heavy lifting to local officials and private and academic researchers who are more reactive to direct feedback from their communities.
In 2007, former agency director James Mason noted that of course, the CDC is "going to have some political oversight and political influence…It's inherent and necessary." But he stressed that it's the responsibility of CDC leadership to stand up to political interests when needed.
During the pandemic, that didn't happen. Not only did the agency consider political factors when making what were most often presented as purely science-based decisions, but officials frequently hid, ignored, or distorted legitimate data either out of incompetence or to appease their political bosses.
The CDC has also been a superspreader of COVID misinformation. To justify universal mask mandates, Walensky spent months citing a junk study on their efficacy in schools, exaggerating the risks of breakthrough infections among the vaccinated, and misrepresenting a study on outdoor COVID transmission, according to its author.
The CDC claimed the delta variant was as transmissible as chickenpox, which isn't true—it turns out the agency had used inaccurate data from a New York Times infographic. It also promoted an infographic on cloth masks using data that were not statistically significant. Meanwhile, the CDC has not run a single randomized controlled trial on the efficacy of masking since the beginning of the pandemic.
In the vaccine rollout, the CDC told the elderly they needed to wait in line behind essential workers, including young and healthy school support staff, corporate tax lawyers, and magazine fashion editors. In its noble zeal to convince parents to get their children vaccinated, the CDC used old data that the agency knew were no longer valid to falsely claim hospitalizations were rising among adolescents; it misrepresented a study to exaggerate the dangers faced by unvaccinated children, and it falsely claimed that kids who get COVID are more likely to develop diabetes.
Under both the Trump and Biden administrations, the CDC publicly cast doubt on the value of N95 masks, vaccines, and diagnostic tests at times when there were supply shortages or when it was politically expedient. Both presidents even used the CDC to exert federal control over state-level housing policy, repeatedly extending an unconstitutional ban on evictions based on junk science.
Nor is this laundry list of blunders and machinations that put politics ahead of public health unusual for the modern CDC, an agency that began as a post-World War II effort to eradicate malaria in the United States but now is in charge of investigating everything from car accidents to sports injuries to gun violence to teen vaping. Despite having a budget that is 14 times larger than it was in the late '80s, today's CDC is less prepared than ever to address its founding purpose: controlling infectious diseases.
Once the politicians in charge learn that they can gain influence and funding for pet issues by couching them as important for Americans' health, there is no end to what arenas they will task public health officials with asserting control over.
The CDC was once a poster child for the movement by many federal entities starting in the 1970s toward an approach known as "regulatory science," which aimed to create impartial standards for regulatory action that would be evidence-based and apolitical, and therefore trustworthy and consistent. But none of these reforms changed the underlying incentives of the CDC or other agencies or of their political overseers. The public choice implications remained the same: Politicians want to look good to voters; bureaucrats depend on politicians for their job; and so bureaucrats will do what it takes to make politicians look good, no matter how unmoored from objective data a particular favored policy may be.
Political concerns also ensure that the CDC is structurally incentivized to be overly cautious, making its officials slow to act in a crisis and reluctant to look outside the agency for help. This is what led to the CDC's greatest blunder at the beginning of the pandemic, when it banned academic, private, and nonprofit laboratories from developing diagnostic tests, delaying their arrival by at least two months and leaving both government and private scientists blind to the spread of the virus. When the agency finally released its own test, it was poorly designed, prone to contamination, and inaccurate.
None of this was unpredictable. Even after the CDC got a chance to stress-test its crisis response during the H1N1 or "swine flu" virus outbreak of 2009, it failed to address known shortages of N95 masks, ventilators, and other critical medical equipment, partly due to political interference by the Obama administration. In an even more recent harbinger of what was to come, during the Zika virus outbreak starting in 2016, the CDC mishandled the development of a diagnostic test while shutting out commercial manufacturers.
So how do we stop another predictably disastrous response before the next pandemic? Even serious proposals that address the CDC's problems by adding on more layers of oversight and red tape are doomed from the start. These attempts only add greater scope for lobbyists and politicians to exert influence and exploit loopholes. Such reforms miss the fundamental reality that centralizing control over public health, especially at the federal level, necessarily results in sclerosis, risk aversion, and mission creep.
Today we can see the costs in thousands of lives lost unnecessarily, and Americans are finally fed up. But the pandemic did not create this reality, it simply exposed it.
We can look to examples of localized, distributed public health systems in other countries that proved themselves during the pandemic. Consider what the outcome might have been here if the CDC hadn't monopolized testing early on and instead taken a cue from its South Korean counterpart. After confirming their first four COVID-19 infections, health officials there rushed to work with biotech companies on a diagnostic test and were able to deploy it within a single week.
In Germany, government health authorities partnered with private labs around the country to create a broad testing network early on, and rapid tests were available in vending machines while the U.S. was still struggling through supply shortages. Perhaps most importantly, countries whose public health authorities were transparent and maintained the public's trust have seen higher rates of voluntary participation in vaccination and other efforts to stem the community spread of the virus.
CDC veteran Martin Cetron has warned colleagues for years of a phenomenon he terms a "bankruptcy of trust," when people no longer place their faith in public officials, allowing speculation and misinformation to fill the void. Now that the pandemic is functionally over, it's clear that the CDC has long been on the path toward its utter failure to plan for or competently address the foundational reason for its existence. And Americans have good reason to rethink their confidence in the federal government's ability to protect their health.
Written and produced by Justin Monticello. Edited by Isaac Reese. Graphics by Reese, Tomasz Kaye, and Nodehaus. Audio production by Ian Keyser.
Music: "Robotic Butterflies" by Evgeny Bardyuzha; "We Fall" by Stanley Gurvich; "Free Radicals" by Stanley Gurvich.
Photos: BSIP/Newscom; BSIP/Newscom; Sarah Silbiger/UPI/Newscom; Shawn Thew - Pool via CNP/ZUMAPRESS/Newscom; Alex Edelman/ZUMA Press/Newscom; SMG/ZUMA Press/Newscom; Simon Shin/ZUMA Press/Newscom; Michael Brochstein/ZUMAPRESS/Newscom; Adam Schultz/White House/Newscom; Brazil Photo Press / SplashNews/Newscom; Tom Williams/CQ Roll Call/Newscom; Polaris/Newscom; Jonathan Alpeyrie/Polaris/Newscom; Aimee Melo/dpa/picture-alliance/Newscom; Julian Stratenschulte/dpa/picture-alliance/Newscom; Sven Hoppe/dpa/picture-alliance/Newscom; CNP/AdMedia/Newscom
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